Provider Demographics
NPI:1992088009
Name:NEUROLOGY CENTER OF FLORIDA LLC
Entity type:Organization
Organization Name:NEUROLOGY CENTER OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-624-6900
Mailing Address - Street 1:2808 ENTERPRISE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2753
Mailing Address - Country:US
Mailing Address - Phone:386-624-6900
Mailing Address - Fax:386-624-6993
Practice Address - Street 1:2808 ENTERPRISE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2753
Practice Address - Country:US
Practice Address - Phone:386-624-6900
Practice Address - Fax:386-624-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-25
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty